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    Real-world experience provides clarity to intravitreal injection misconception

    Steroid implants a second-line therapy for patients with suboptimal response to anti-VEGF therapy


    Take-home message: Using real-world experience, a retinal surgeon highlights the optimal settings for use of steroid implants for treatment of diabetic macular edema.



    Los Angeles—Within the past year, two sustained-release intravitreal injection implants—dexamethasone (Ozurdex, Allergan) and fluocinolone (Iluvien, Alimera Sciences)—were approved for the treatment of diabetic macular edema (DME) by the FDA.

    Dexamethasone is designed to be implanted every 6 months, whereas fluocinolone is designed to be have a treatment effect for 36 months; these indications were based off results from the respective pivotal studies.

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    Retina specialists, however, are finding a diminished durability effect with dexamethasone. (Fluocinolone had not yet started shipping by the end of 2014, limiting its real-world experience.)

    “We don’t yet know if there is a diminished real-world durability effect with [fluocinolone], or what the best way to handle the diminished effect may be,” said Andrew Moshfeghi, MD, Los Angeles.

    Physicians may opt to “touch up” patients with anti-vascular endothelial growth factor (VEGF) agents until insurance companies determine how often they will reimburse for the implant, Dr. Moshfeghi explained.

    “We also have to think about the implications—if we re-implant, are we risking a higher rate of glaucoma?” he posed.

    In his real-world experience, those issues have not manifested in patients who needed to be treated earlier than every 6 months with dexamethasone, Dr. Moshfeghi said, although he only has limited experience with early re-treatment.

    NEXT: When to use steroid implants

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